Medical Billing Manager

The Center for Inherited Blood Disorders (CIBD) is a passionate non-profit organization dedicated to delivering high-quality, comprehensive, and family-centered care that significantly enhances the lives of children and adults with blood disorders. By choosing a career with us, you'll be joining a vibrant team committed to advancing public health while also investing in your personal and professional growth. Explore the opportunity to make a real difference in the community while developing your skills in a supportive, mission-driven environment. Your contributions will help shape our future and transform lives!

Job Summary

Reporting to the Chief Financial Officer (CFO), the Medical Billing Manager will be responsible for billing operations including workflow oversight for processing of claims/coding for clinical and infusion services team leadership. The Medical Biller Manager manages a team of billers and ensures team compliance with county, state, and federal regulations, in the preparation and submission of claims to insurance companies, government agencies to receive payment for medical services rendered for reimbursement. The Medical Billing Manager also has substantive knowledge of industry standards and insurance companies, billing, and coding regulations, and follow standards in accordance with Centers for Medicare & Medicaid Services (CMS), California Children’s Services (CCS), Genetically Handicapped Persons Program (GHPP) and all other State and Federally sponsored programs.

Department: Finance Schedule: M - F, 8:30 - 5:00 Location: On-site

Essential Duties

Database Management: Maintain and update accurate databases with insurance companies. Review high level complaints and respond back within department standards.

Compliance: Ensure compliance with industry standards set by the Centers for Medicare & Medicaid (CMS), commercial insurance plans, Medi-Cal, and county managed care plans regulations.

Supervise Operations: Direct daily charge entry, claim scrubbing, submission, and payment posting.

Lead the Team: Recruit, train, mentor, and evaluate remote and on-site billing and collections staff.

Optimize Epic: Manage and resolve Epic charge router, claim, and account workqueues efficiently.

Denial Management: Analyze rejections to implement effective appeal strategies.

Payer Compliance: Maintain up-to-date knowledge of Medicare, Medicaid, and commercial guidelines.

Monitor Accounts Receivable: Track A/R aging and implement strategies to reduce outstanding days.

Financial Reporting: Track monthly revenue cycle KPIs, DSO, and aging reports.

Requirements

Bachelor’s degree in Healthcare Administration, Finance, or equivalent experience.

Graduate from an accredited Medical Billing program.

Minimum of 5 years of experience in ambulatory /outpatient medical billing setting.

Minimum of 2 years of direct experience with infusion billing, J-codes, and pharmacy benefits.

Minimum of 2 years of supervisory experience.

Minimum of 2 years experience with EPIC EMR/PM software.

Experience working with all payers – commercial, government, Medicare, Medicaid.

Deep expertise in CPT, ICD-10, HCPCS codes, and modifiers.

Required Licenses/Certifications

Basic Life Support(BLS) Certification (or ability to obtain within the first three months of hire).

HIPAA Training (or ability to complete within one month of hire).

Additional Required Qualifications

Working knowledge of CCS/GHPP/Medi-Cal/HIPAA regulations and requirements and understanding of third-party payer methods and regulations.

Working knowledge of HCPC/E&M/CPT & ICD-10 codes related to Hematology and related services.

Working knowledge and understanding of the relationship between procedure and diagnosis compatibility to maximum reimbursement.

Advanced knowledge of billing denials and appeals processes.

Preferred Qualifications

Certified Professional Biller (CPB), Certified Billing and Coding Specialist (CB Certified Medical Billing Specialist Certificate (CMBS) or similar certification.

Benefits

100% employee coverage and 50% dependent coverage of medical and vision; 99% employee coverage of dental

Life insurance

Paid Time Off

10 observed paid holidays

403b retirement plan with 4% match

Compensation listed is the expected salary base at time of hire. Actual compensation offered will be determined by factors such as location, level, job-related knowledge, skills, and experience.

About the Organization The Center for Comprehensive Care & Diagnosis of Inherited Blood Disorders (CIBD), a 501(c)3 non-profit organization, is committed to providing comprehensive care for patients and their families with rare, chronic inherited blood disorders. CIBD is a part of a nationwide network of over 140 Hemophilia Treatment Centers that use multidisciplinary teams of blood disorder specialists to provide expert comprehensive diagnosis, medical care, outreach, education, outcomes monitoring, surveillance, and prevention services to people with Hemophilia, Sickle-Cell Anemia, Thalassemia, Von Willebrand Disease, Mast Cell Activation Syndrome (MCAS) and other related benign hematology conditions. CIBD is the regional grantee for the Western States Region for Hemophilia, the Pacific Sickle Cell Regional Collaborative (PSCRC) and Networking California for Sickle Cell Care (NCSCC) providing regional leadership, fiscal and administrative oversight, grants management, capacity building, clinical education, technical assistance, evaluation, and outreach to public and private health agencies at the local, state, and federal levels.

The Center for Inherited Blood Disorders is an Equal Opportunity/Affirmative Action Employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the company's non-discrimination policy.

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable and welcoming.